Lockdown, Unwanted Pregnancy and Demand for Maternal and Child Health Services: Concern and Future Strategy to Combat
Unwanted pregnancies and baby boom will be the effect of the lockdown and will have a great impact on future demographic outcome and additional burden on the available healthcare system in the country.
The Youth
Indian government decision on nationwide lockdown was right and important to check the spread of COVID-19 infections and fatality. The concern is about the possible emerging demographic scenario in the country due to lockdown. As the global debate and discussion on the possibility of unwanted pregnancy and baby boom, other than gender-based violence will be the effect of the lockdown and will have a great impact on future demographic outcome and additional burden on the available healthcare system in the country. A latest projection released by UNFPA on 27 April 2020 added that if lockdown continues to 6 months, close to 7 million unintended pregnancies are expected to occur, 31 million additional cases of gender-based violence may occur and 47 million women may not be able to access the modern contraceptives in low and middle-income countries.
In India, where still we are away from the replacement level fertility and many states facing threat of high fertility, low contraception use and high pregnancy, we can’t ignore the possibilities of the high unwanted pregnancy, unsafe abortion and high birth due to poor access to contraception and gender-based violence. As gender-based violence increases, the risk of unwanted pregnancy by more than two times. Author own study based of national Family Health Survey, 2015-16 data have found that the women who had experienced domestic violence in last 12 months were found to be 1.59 times more likely to have an unwanted pregnancy in the last 12 months with more on sexual violence.
The question arises why this phenomena of unintended pregnancy will happen and what will be repercussion. The reason is low contraception use and high unmet need as one important factor. As per National Family Health Survey, 2015-16; CPR (contraceptive prevalence rate) is still only 53 percent of which 36 percent contributed by female sterilization only. The unmet need is still high of 13 percent draw attention especially in rural areas where fertility rate is high. Due to lockdown, poor availability and accessibility of contraception and use of male spacing method is much more minimal.
Latest estimate by UNICEF added that around 116 million babies will be born under the shadow of the COVID-19 pandemic with highest of 20.1 million in India, followed by China (13.5 million), Nigeria (6.4 million), Pakistan (5 million), Indonesia (4 million) and United States of America (3.3 million) at sixth position, in the 9 months since the pandemic declaration. Most of these countries had high neonatal mortality rates (excluding USA) even before the pandemic and may see these levels increase with COVID-19 conditions.
So, the consequence of expected high unwanted pregnancy will be either possibility of high demand either for abortion measures or to deliver. As we are facing challenges of health infrastructure and human resources at the time of pandemic, in both the situation, more additional pressure on available services especially maternal and healthcare services can’t be ignored at both facility and community level. This will be more in rural areas where already sparse of health services availability and accessibility is also a concern for the long time, although after National Health Mission, situation has improved more.
So, the need at the time for next one year since the time of lockdown for government is to be ready with more Maternal and Child Health (MCH) related infrastructure for institutional delivery, newborn care facility along with antenatal and post natal care at facility and community level.
Second, the government should also make aware and sensitize the couple to avoid unsafe abortion in case of having an unwanted pregnancy, psychological counselling on the possibility to continue the pregnancy or needed abortion may be the strategy to reduce the risk of maternal death along with child death.
Third, deploy more Para-medical staffs to cater to the need of reproductive and MCH services in rural areas where more poor and vulnerable population is living. The trained traditional birth attendants (TBAs) can be an option for safe delivery in rural areas where health facilities are at the distant and having more MCH load.
Fourth, as the pregnant women may be afraid to deliver in the hospital due to risk of COVID infection; strategy should be to proper counselling and assurance with disinfecting the delivery ward and newborn care unit and it should not be close to the COVID patient ward.
Fifth, at the community level; awareness and sensitization for availability of required services in the health facilities and safe abortion for the couple who don’t want to continue such pregnancy, ASHA worker and Anganwadi worker can be major catalyst and they can be incentivised for at least next one year to overcome the possible more unwanted pregnancy and associated risk burden. As after that the demographic and reproductive behaviour of population will be settled to normal pace.
Importantly, as the field survey and data collection of fifth round of National Family Health Survey (NFHS) was underway and has not completed in all states/UTs, somewhat different picture of reproductive behaviour, fertility, family planning in addition to maternal and child health services can’t be ignored. Hence, demographer and public health researchers think wisely at the programme and policy level to support the government at national, regional and state level.
Dr. Rajesh Raushan is Assistant Professor at Indian Institute of Dalit Studies, Delhi and currently holding Post-Doctoral Fellow position under Indian Council of Social Science Research (ICSSR), Delhi, India. Author can be contacted on rajesh.rajiips@gmail.com